Diagnostic Accuracy of DW MRI in Early Detection of Endometrial Carcinoma

Abstract
Introduction: Endometrial carcinoma is the most common gynecological malignancy and the sixth most common neo-plasm worldwide. The role of MRI in patients with histolog-ically proven endometrial cancer is to evaluate the depth of myometrial and cervical invasion and detect pelvic lymph node involvement pre-operatively thereby helping to determine the need for lymph node dissection. DW-MRI provides im-portant new information noninvasively. This unique modality is helpful in initial staging of known malignancies, differen-tiating benign from malignant lesions, as a biomarker for treatment response and determining the presence of disease recurrence.
Aim of Study: The aim of this study is to assess the diagnostic accuracy of diffusion weighted imaging and ADC value in early diagnosis of endometrial cancer in high risk patients decreasing the need for surgical interventions for diagnosis.
Patients and Methods: This study included 33 patients, 21 patients had pathologically proven endometrial cancer, and 12 patients had endometrial hyperplasia with control group of 36 patients referred to the Radiology Department from Surgical Department to assess the endometrium. Pelvic DCE-MR was done and DWI was obtained with 3 b-values including 0, 300 and 600mm/sec.
Results: There is statistically significant difference between the benign and malignant group with p-value=0.001 in which Sensitivity=90.0% Specificity=83.3% Accuracy=85.2%. The ADC value of benign group ranged from (0.8 to 2), the ADC value of malignant group ranged from (0.5 to 1.3). There was significant overlap between benign and malignant group as regards the ADC value however if we use cut off value of 0.6 for malignant lesions and 1.6 for benign lesions, the specificity will be 77.1% for benign and 100% for hyperplasia. Our results revealed that the inclusion of CE MRI resulted in statistically insignificant improvement of the diagnostic accuracy and sensitivity in differentiation between benign and malignant group (p 0.06) in which Sensitivity=30.4% Specificity=38.5% Accuracy=33.3%.
Conclusion: Our results revealed that the inclusion of CE MRI resulted in statistically insignificant improvement of the diagnostic accuracy and sensitivity in differentiation between benign and malignant group. The diffusion weighted imaging ADC value improve the efficacy and diagnostic accuracy in early diagnosis of endometrial cancer in high risk patients decrease the need for surgical interventions for diagnosis.